Archived: Aldwick House Care Home

The last inspection took place on 25 and 26 February 2016. As a result of this inspection, we found the provider in breach of two regulations, one relating to safe care and treatment and the other associated with the need for consent. We asked the provider to submit an action plan on how they would address these breaches. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection, we found the provider and manager had taken appropriate action and these regulations had been met. As a result, the overall rating for this service has improved from 'Requires Improvement’ to ‘Good’.

Aldwick House is registered to provided accommodation and nursing care for up to 32 people with a range of healthcare needs, including a diagnosis of dementia. At the time of our inspection, 30 people were living at the home. When capacity was available, the home also offered short breaks or respite for people, providing care on a short-term basis. Aldwick House is a large detached, older style property, with accessible gardens, close to the town of Bognor Regis and the coast. Communal areas include a large lounge and dining area with a conservatory. All rooms are of single occupancy, apart from one, where two people have shared a room for a number of years. There were plans to replace the lift in the near future.

The manager came into post at the home in January 2017 and was in the process of becoming registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Supervision meetings for some staff had lapsed since the last registered manager left employment and the new manager had started. The manager was aware of this and had identified it as an area for improvement. People and relatives liked the meals on offer, however, arrangements within the home made it difficult for some people to eat independently. Staff were not always positive towards making the mealtime a sociable experience for people.

Staff had completed a range of training and attended staff meetings to ensure they had the skills and guidance necessary to support people effectively. Staff were encouraged to study for qualifications, such as diplomas in health and social care, and new staff completed the Care Certificate, a universally recognised qualification. Consent to care and treatment was sought in line with legislation. People received support from healthcare professionals and had access to healthcare services.

People and their relatives felt Aldwick House was a safe place to live. Risks to people had been identified and were assessed appropriately. Guidance was in place for staff on how to manage risks. Staff had been trained to recognise the signs of potential abuse and knew what action to take. Staffing levels were sufficient to meet people’s needs and there were plans to increase staffing levels. Safe recruitment systems were in place. Medicines were managed safely.

Positive, warm and friendly relationships had been developed between people and staff. We observed positive interactions between staff and people. People and their relatives were encouraged to express their views in relation to their care. People were treated with dignity and respect. At the end of their lives people were supported to have a comfortable, dignified death.

A range of activities was provided for people from an activities co-ordinator employed by the home and an external entertainer who visited each weekday. People were also provided with individual support where they chose not to be involved in group activities. The provider had put in place a strategy to improve the way people living with dementia were supported and cared for. Care plans provided detailed information about people’s care needs and guidance to staff on how they wished to be supported. People and relatives felt confident that any concerns or complaints they had would be addressed appropriately.

People and their relatives were involved in developing the service and regular meetings took place. Questionnaires had been sent out to obtain people’s feedback. The home was well managed and good leadership was evident. Staff spoke highly of the new manager, who felt that they now had a sound staff team in place. Relatives were complimentary about the care their family members received. A range of systems was in place to measure and monitor the quality of care delivered. Where actions were identified, steps were taken to make improvements.

Aldwick House Care Home is a 32 bedded nursing home that provides care and support to older people living with dementia. At the time of inspection there were 28 people living at the home. The registered manager told us that everyone who was living at the home had a diagnosis of dementia and that this was their primary need.

During our inspection the registered manager was present. There had been a change of manager since our last inspection. The current registered manager has been in post since October 2015 and had just recently registered with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People said that they felt safe, free from harm and would speak to staff if they were worried or unhappy about anything.

Risks to people had not always been managed safely. Care plans and assessments were not always updated to reflect changes in needs.

People told us that they were happy with care they received. One relative told us, “My family member is content, happy and settled here. I feel all their care needs are being met.” However, we found that some people did not receive care and support which met their individual needs. This included pressure area care, meeting nutritional needs and dementia care.

Staff understood the principles of the Mental Capacity Act 2005 (MCA), the Deprivation of Liberty Safeguards (DoLS) and how they affected their work. These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty these have been authorised by the local authority as being required to protect the person from harm. They confirmed they had received training in these areas. However, the principles of the MCA had not always been put into practice.

The registered manager advised us no one accommodated had capacity to make decisions for themselves. People’s relatives or representatives had not always been involved in decision making processes about their care when required. DoLS applications for three people had been appropriately made to ensure people’s human rights were upheld. However, there was no recorded guidance for staff to follow to ensure care provided was appropriate.

People said that the food at the home was good. There was evidence of people being offered choices in relation to food and drink.

We heard staff speaking kindly to people and they were able to explain how they developed positive caring relationships with people.

The registered manager had begun to make improvements required to the environment to help meet the needs of people living with dementia. They have also begun to improve care records to ensure care delivery is person centred and they have begun to improve the provision of activities for people. We have made a recommendation that further work is done in these areas in order to meet people’s individual needs.

People, relatives and staff told us that there were enough staff on duty to support people at the times they wanted or needed. We also found that this was the case.

Staff told us they felt well supported in their work by the registered manager. Training was provided during induction and then on an on-going basis. A training programme was in place that included courses that were relevant to the needs of people who lived at Aldwick House Care Home.

The registered manager had arranged meetings with people and their relatives meetings to enable people to express their views and to be involved in making decisions about the service.

The registered manager also provided us with documentary evidence that demonstrated how the service had been monitored. They included routine health and safety checks and maintenance of the environment, the management of medicines and infection control.

A written complaints procedure was in place that showed that, where concerns or complaints had been raised, the manager would respond to them on an individual basis in writing. Since appointment, the registered manager had not yet received any complaints. There was evidence to demonstrate that the findings from individual complaints would be incorporated into the provider’s auditing system in order to identify trends and to learn from them.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care records did not provide staff with sufficient up to date information to ensure care was delivered safely and met people’s needs. The registered provider had not ensured, where people lacked capacity to make decisions for themselves, the principles of the Mental Capacity Act had been followed. You can see what action we have told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

From our observation we saw that people are treated with respect and dignity by the staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were told no applications had been made under DoLS as it had not been necessary. The manager confirmed they understood when an application should be made to deprive someone of their liberty and how to submit one.

We observed medication trolleys left open and unattended during times when medication had been administered. This meant that people had access to medication that was not intended for them. A compliance action has been set in relation to this and the provider must tell

us how they plan to improve.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

Recruitment practice was safe and thorough. No staff had been subject to disciplinary action.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safe administration of medication.

Is the service effective?

People's health and care needs were assessed with them and their relatives, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Relatives said that they had been involved in writing them and they reflected people's current needs.

In some instances people had been administered medication covertly. Medication had been hidden in food when people regularly refused to take it. The was no evidence that they had been subject to an assessment to determine if they had mental capacity to make choices about the treatment provided. This meant that people's right to make choices may not have been protected.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safe administration of medication.

Is the service caring?

People were supported by kind and attentive staff. We saw that nursing and care staff showed patience and gave encouragement when supporting people. A relative commented, 'They (the staff) genuinely care. They handle people's different personalities on an individual basis. They care with a capital 'C'!' Another relative said, 'I have been impressed with the patience that staff have shown. I don't feel my mother will be dumped in a chair and left there all day. The staff will always come and speak to her'.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People felt able to speak to the manager if they were unhappy. Two people said that they had found that the manager was approachable.

We looked at minutes of meetings between the manager, people and their families. We found that the manager had been open and responsive, and had addressed concerns raised or suggestions made in a timely manner.

Is the service well-led?

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. They also demonstrated a good understanding of the ethos of the home. Staff also informed us they felt well supported in their work.

As many of the people accommodated were not able to tell us about their experiences, to help us to understand them we used our Short Observational Framework for Inspection (SOFI) tool. This tool allowed us to spend time watching what was going on in a service and helped us to record how people spent their time, the type of support they got and whether they have positive experiences. We spent 50 minutes watching care and support provided to five people in the dining room.

We observed people being served and helped with the main meal of the day. In the main, the care staff on duty knew what support and encouragement people needed to maintain their independence. However we observed a distinct lack of verbal interaction by staff on duty with one person despite several opportunities for them to do so.

We also gathered evidence of people's experiences of the service by looking at a selection of records. We found that care records did not provide nursing staff and care staff with adequate information to follow with regard to when as required medication should be administered to manage challenging behaviour. We also found that procedures for the administration of medication were not sufficiently robust to ensure they had been administered safely.

We spoke with four members of staff, who were on duty. We found that they had a good understanding of their roles and responsibilities.

We spoke to relatives of service users who said they were happy with the quality of care and support provided to their loved ones at the home.

People's needs were assessed and care, treatment and support was planned and delivered in line with individual care plans. People told us they felt safe living at Aldwick house. Staff members had received training in safeguarding vulnerable adults, and a range of other training to promote the safety and wellbeing of service users.

Staff told us they were receiving good training, support, supervision and professional development.

We found evidence that learning from incidents and accidents took place and appropriate changes were implemented. The provider and manager had a range of effective systems that regularly monitored and assessed the quality of service people received. These systems included obtaining feedback from service user and families.